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Dr. Stuart Fromm develops "Knotilus" shoulder stabilization technique

5/14/2012 12:00:00 AM

The Knotilus shoulder stabilization technique is an arthroscopic shoulder surgery technique that was developed by Dr. Stuart Fromm years ago. In the past 4 years he began working with Stryker Orthopedics, one of the largest and most well known orthopedic surgery companies in the world. Several of the techniques Dr. Fromm has developed and patented, have been done by this well known orthopedic surgery company for a variety of different reasons. There is so much that happens "behind the scenes" in bringing a surgical technique from the idea stages all the way to the endpoint of releasing and teaching the surgical technique to orthopedic surgeons, hospitals, and surgery centers around the world. On average, it takes years of extensive development and testing to bring such a technique "to life".
    A brief history/background: There are two main goals in developing better surgical techniques. 1) To make surgical techniques easier for the orthopedic surgeon, and 2) The technique needs to give better and more predictable/reproducible outcomes or success rates.
    For example, if there is a surgery that is too difficult to perform -then few surgeons will take the time to struggle through the learning curve to learn a difficult technique and thus the results can be substandard or unpredictable. Dr. Fromm is always thinking of a better way to develop techniques that are both easier to perform while at the same time giving better and more reproducible outcomes for orthopedic surgeons around the world - and this translates into better results for patients with less morbidity.
    Shoulder surgery has changed significantly over the last 15 years. The development of arthroscopic surgery techniques for the shoulder has enabled surgeons to diagnose and perform many surgeries with better access and visualization allowing for more surgical techniques that have improved outcomes and have decreased morbidity for patients. In other words, newer arthroscopic surgery techniques for the shoulder have made it better for surgeons, allowing them to fix things they couldn't fix before, which has dramatically enhanced the postoperative period for patients which means less pain, quicker recovery, and far fewer complications. This is especially true for surgical stabilization techniques for the shoulder. Shoulder instability usually results from torn labral tissue, which leads to pain and / or instability of the shoulder. The labral tissue is a ring of tissue that attaches to the peripheral rim of the glenoid (shoulder socket). Once this labral tissue tears off the shoulder socket, it rarely heals on its own which can lead to chronic pain and instability of the shoulder. Worse yet, this can lead to arthritis of the shoulder joint at an early age.
    The Knotilus surgical technique is an arthroscopic surgery technique to repair all types of labral tears, including Bankart tears and SLAP tears. The Knotilus technique is more advanced than current techniques. For one, it allows the surgeon to perform the surgery through only two portals (tiny stab incision in the skin). One portal is for the arthroscope and the other is to perform the actual surgery. This makes it easier for the surgeon in many ways. Previous techniques usually required multiple portals. Also, the Knotilus technique is truly "knotless". Tying a knot in the suture is always a weak point - as knots can slip, loosen, come apart, and even break. Some knots are pre-tied and some knots the surgeon has to tie himself. This technique does not use any knots. Rather this technique uses a continuous loop of suture - a "third generation suture" that has exceptional strength and fatique properties. This loop is passed around the torn labral tissue and then is captured by a suture anchor (a small anchor that is secured into a drill hole in the bone). Another advancement of this technique is that the suture is locked into place once the anchor is placed whereas other techniques can rely on friction to hold a suture in place. Relying on friction can lead to the risk of slipping and thus loosening of the repair / construct. Since the Knotilus technique locks the suture in place there is no risk of slipping. Lastly, this technique can usually be performed faster than previous techniques, which is almost always better for the patient. In summary, this technique is overall easier and more reproducible / reliable for surgeons - which translates to better outcomes and success rates for patients. With that said, it should be clear that the other current techniques are not "bad"; as there are many good techniques that have been developed over the years, however, medicine is always striving to advance and improve.
    What goes into the development of a technique? Stryker, like most companies, rely on many different teams for developing such a technique - teams and companies from all over the world. For example, a company by the name of Tag, which is based out of Israel makes the instrumentation . Dr. Fromm has worked with them on many different projects and they are well known for outstanding craftsmanship. The company who makes the "suture" is a company that specializes in making synthetic cables for all types of applications including the military. With that said, the suture that was used for this technique is really a miniature replica of a strong synthetic cable. Stryker, the company itself, is based out of many different global locations.   Dr. Fromm along with Stryker, have done numerous "labs" over the years - labs based around the country to test different prototype designs when under development. When these labs are held, all of these different groups fly in from around the world for the testing, including numerous engineers and marketing personnel, each person playing a specific role, Once the technique, implants, and instrumentation are perfected, there is the extensive process of making sure the technique is safe with one of the last steps to include obtaining FDA approval, as well as patent protection and so on.
    In summary, it is always nice to see all of this hard work over the years finally succeed once a surgical technique, implants, and instrumentation are perfected and released globally. Even when a technique reaches that point, it does not end there. Most companies have their own "check and balance" - usually including a limited release to a select few surgeons to use first. Once the feedback and documentation from these surgeons are obtained, then the technique can be released - first domestically and then internationally. This usually involves extensive networks of companies and sales representatives from around the world. Then there is always continuous monitoring of feedback, usage numbers, and so on - all of which is exciting to see and follow when a technique is being used. Probably the most exciting and rewarding part for Dr. Fromm is hearing the feedback personally from surgeons(see below) and hospital staff from around the world that his years of determination, committment, and hard work have been a success.

Feedback from surgeons:
    Just finished anterior-posterior labral repair with Dr. Price. He used one Knotilus anterior, two Knotilus posterior. Looked great, worked great. Dr. Price liked it and said it was very simple to use. This product is great.

    I just wanted to send a quick recap on our first Knotilus case! Dr Lee successfly implanted three Knotilus anchors for a Bankart repair this morning. The case could not have gone better! He really loved the luggage tag technique and how muc of the labrum he was able to pull towards the glenoid. Dr. Lee was overall really impressed with the product. Dr. Lee just told me he is using the Knotilus on all labral tears now!

Dr. Bryan Den Hartog will receive the Distinguished Professional Achievement Award from Northwestern College-Iowa

9/13/2011 12:00:00 AM

Northwestern College will present three of its alumni with awards recognizing their accomplishments and service during Homecoming Saturday, Oct. 1. Dr. Den Hartog will be presented with the Distinguished Professional Achievement Award of 2011. Please see the attached Northwestern link for the full news article. Congratulations Dr. Den Hartog!
Northwestern College

Black Hills Orthopedic and Spine Center presented with the "Extra Inning Award"

8/17/2011 12:00:00 AM

Paul Richter, athletic trainer at Black Hills Orthopedic and Spine Center was presented the Extra Inning Award at the 2011 Post 22 Firecracker Tournament. BHOSC and our athletic trainers were given this award in recognition of providing athletic training for 13 plus years to the many athletes who have participated in the Post 22 baseball program.

Thank you to all our athletic trainers for their dedicated service. Congratulations!

Physical therapist Jesse Ham Golf stretching program feature in Rapid City Journal

6/22/2011 12:00:00 AM

Jesse Ham, physical therapist at BHOSC featured in the Rapid City Journal article "Play pain-free" Stretching can prevent golf injuries.

See web link for this article:
http://www.rapidcityjournal.com/lifestyles/health-med-fit/article_ed41d8e4-991a-11e0-bdbe-001cc4c03286.html

Podiatry Feature in the Rapid City Journal- Dr. Kent Renaud

3/16/2011 12:00:00 AM

"Nail issues can increase with warm weather"

     As the weather warms up and we become more active, our feet often see an increase in use. This increased activity can bring about nail problems that may result in an ingrown nail. This nail condition can range from a simple sharp edge that irritates the skin to a large piece of the nail imbedded deeply in the skin. A mild irritation may develop or it may progress to a serious infection that could ultimately result in a toe amputation.
     Underlying medical conditions such as diabetes and poor circulation make nail problems much more serious. Age can also play a role in healing nail concerns.
     The anatomy of the human nail is relatively simple. The nail is referred to as the nail plate. It grows outward toward the end of the toe from the nail root, also called the matrix. The shape of the matrix determines the shape and thickness of the nail plate. The matrix is often damaged when the nail is injured by heavy objects landing on the toe or the stubbing of the toe.
     Fungal infections are another common cause of injury to the matrix. The white crescent shape seen at the base of the nail is the matrix and often is referred to as the lunula.
     Sports activities such as running, soccer, basketball, and skiing can cause repeat minor trauma to a nail that over time can result in damage to the matrix. The cuticle is the thin strip of skin that seals the skin of the digit to the nail. Its job is to keep this junction tight so bacteria cannot enter. Care should be taken to not disrupt this thin protection.
     There are a number of situations that can lead to nails becoming ingrown. We will look at some of the more common reasons an ingrown nail may develop. Genetics can contribute to underlying bone structure of the toe and therefore the shape of the matrix and ultimately the nail. Some people tend to have nails that curve in at the edges: this may make them more prone to an ingrown nail.
     Often people with nail edges that curve in suffer with repeat ingrown nails. These repeat infections can lead to deeper more serious bone infections if it is not properly cared for. Damage to the nail and the matrix may result in a deformed nail plate that digs into the skin edges as it grows forward.
     Athletics is a common cause of ingrown nails, especial if the nails are not trimmed properly and frequently. Even small injuries such as toes bumping against shoes or boots while running can lead to nail matrix injury and a permanent nail deformity.
     Be sure shoe gear fits perfectly to help reduce this problem. Shoes that are too large are responsible for many nail injuries as they allow the foot to move excessively in the shoe.
     I am sure everyone is familiar with the consequences of dropping a heavy object on a toenail. Not only is it extremely painful, but permanent nail deformity is common.
     Treating an ingrown nail consists of a number of different options. Simply trimming away the sharp point that is causing the irritation may work in some cases. Be sure not to leave a portion of the nail imbedded in the skin.  This is a common problem as it can be extremely painful to get all of the offending piece out. You may need to have a physician remove the nail side that is ingrown. This can be done in a temporary fashion, allowing it to grow back over several months.
     A permanent removal of the edge may be needed if the problem returns. The entire nail can be removed permanently or temporarily if the whole nail is causing a problem.  This is often the case if the matrix has been damaged by a heavy object of a harsh toe stubbing. Antibiotics may be needed if an infection is present.
     See your foot specialist if an ingrown nail is not improving in a few days. If you are diabetic, you should seek care at the first sign of nail problems.